Extracorporeal Life Support After Cardiac Surgery in Children: Outcomes From a Single Institution

<jats:title>Abstract</jats:title><jats:p>Extracorporeal life support (<jats:styled-content style="fixed-case">ECLS</jats:styled-content>) is used after congenital heart surgery for several indications, including failure to separate from cardiopulmonary bypass, postoperative low cardiac output syndrome, and extracorporeal cardiopulmonary resuscitation. Here, we assessed the outcomes of <jats:styled-content style="fixed-case">ECLS</jats:styled-content> in children after cardiac surgery at our institution. Medical records of all children who required postoperative <jats:styled-content style="fixed-case">ECLS</jats:styled-content> at our institution were reviewed. Between 2003 and 2011, 36 (1.4%) of 2541 pediatric cardiac surgical cases required postoperative <jats:styled-content style="fixed-case">ECLS</jats:styled-content>. Median age of patients was 64 days (range: 0 days–4.1 years). <jats:styled-content style="fixed-case">ECLS</jats:styled-content> was in the form of either extracorporeal membrane oxygenation (<jats:styled-content style="fixed-case">ECMO</jats:styled-content>; <jats:italic>n</jats:italic> = 24) or ventricular assist system (<jats:styled-content style="fixed-case">VAS</jats:styled-content>; <jats:italic>n</jats:italic> = 12). Mean duration of <jats:styled-content style="fixed-case">ECLS</jats:styled-content> was 4.9 ± 4.2 days. Overall, 21 patients (58%) were weaned off <jats:styled-content style="fixed-case">ECLS</jats:styled-content>, and 17 patients (47%) were successfully discharged from the hospital. Patients with biventricular heart (<jats:styled-content style="fixed-case">BVH</jats:styled-content>) had higher survival‐to‐hospital discharge rates compared with those with univentricular heart (<jats:styled-content style="fixed-case">UVH</jats:styled-content>) (<jats:italic>P</jats:italic> = 0.019). Regarding <jats:styled-content style="fixed-case">ECLS</jats:styled-content> type, <jats:styled-content style="fixed-case">UVH</jats:styled-content> patients who received <jats:styled-content style="fixed-case">VAS</jats:styled-content> showed higher rates of device discontinuation than <jats:styled-content style="fixed-case">UVH</jats:styled-content> patients who received <jats:styled-content style="fixed-case">ECMO</jats:styled-content> (<jats:italic>P</jats:italic> = 0.012). However, rates of hospital discharge were not significantly different between <jats:styled-content style="fixed-case">UVH</jats:styled-content> patients who received <jats:styled-content style="fixed-case">VAS</jats:styled-content> or <jats:styled-content style="fixed-case">ECMO</jats:styled-content>. Surgical interventions, such as banding of <jats:styled-content style="fixed-case">B</jats:styled-content>lalock–<jats:styled-content style="fixed-case">T</jats:styled-content>aussig shunt to reduce pulmonary blood flow or placing bidirectional cavopulmonary shunt to minimize ventricular volume overload, were effective for weaning off <jats:styled-content style="fixed-case">ECLS</jats:styled-content> in patients with <jats:styled-content style="fixed-case">UVH</jats:styled-content>. <jats:styled-content style="fixed-case">ECLS</jats:styled-content> is beneficial to children with low cardiac output after cardiac surgery. Rates of survival‐to‐hospital discharge were higher in <jats:styled-content style="fixed-case">BVH</jats:styled-content> patients than <jats:styled-content style="fixed-case">UVH</jats:styled-content> patients. Additional interventions to reduce ventricular volume load may be effective for discontinuing <jats:styled-content style="fixed-case">ECLS</jats:styled-content> in patients with <jats:styled-content style="fixed-case">UVH</jats:styled-content>.</jats:p>